New Long Beach paramedic model may be stalled for county review

By Eric Bradley Staff Writer

Posted:
02/16/2013 04:34:35 PM PST

Updated:
02/18/2013 10:03:27 AM PST

L-R: Paramedics Luis Monge and Matt Van Egdon tend to a pregnant patient in possible early labor. Currently each rescue truck for the Long Beach Fire Department is manned by two paramedics. (Brittany Murray / Staff Photographer)

LONG BEACH - A new paramedic model conceived as a cost-saving measure could be delayed as Long Beach Fire Department officials and the director of the county's Emergency Medical Services Agency disagree on a timeframe to implement it. | PHOTOS

The "rapid medic deployment" model, which Fire Chief Mike DuRee said he intended to put into place around mid-March, would staff a single paramedic in each responding vehicle instead of the current practice in which two paramedics are staffed on most city ambulances. The action would reduce the number of paramedics required in the system to save more than $1 million for the cash-strapped city.

Paramedic Luis Monge starts an intravenous line in a pregnant patient in possible early labor. Currently each rescue truck for the Long Beach Fire Department is manned by two paramedics. The city proposed staffing change would place one paramedic and one EMT in the truck. (Brittany Murray / Staff Photographer)

On Friday, DuRee said he expected a pilot program to be close to approval by the county EMS Commission soon after a Feb. 20 meeting of the body's Provider Agency Committee.

However, responding to a question by email, Los Angeles County EMS Agency Director Cathy Chidester wrote that the program needed more scrutiny from other committees. She predicted the issue would then go before the commission at its July meeting.

Chidester was not available for an interview. The EMS Commission meets bi-monthly, with its next meeting scheduled for March 20.

DuRee was unaware of the apparent snag.

"This is the first I've heard of it," he said.

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LBFD command staff has vetted the program for the last six to eight months, and it has been approved by the EMS agency's Governance Committee, the chief said.

"We've complied with every single request that the county has put on us," said DuRee. "I don't see why it should sit on the table and wait."

Among other requirements, fire officials have provided two years of EMS data and moved up its planned switch from labor-intensive patient care reporting on paper to more efficient electronic reporting, said DuRee.

"We've done every single thing because we want to make it right," he said.

The schedule confusion aside, the deployment shift would pair one paramedic with one emergency medical technician on 11 ambulance units, instead of two paramedics on eight units today and two EMTs on three units.

Each of the city's 16 fire engines would also have a paramedic rather than a paramedic on nine engines, the plan says, ensuring that two paramedics will eventually respond to every call.

Though DuRee predicted that the increase in the number of units carrying paramedics would reduce medical call response time overall by about 40 seconds, critics say that two paramedics back each other up and can execute interconnected procedures at the same time, such as intubating a patient while beginning intravenous therapy, or provide care that an EMT cannot.

Paramedic Luis Monge, left and Paramedic Matt Van Egdon right tend to a patient while joined by two others from Engine 1. (Brittany Murray / Staff Photographer)

"This is a budget-driven pilot study and has nothing to do with patient care," said Rex Pritchard, president of Long Beach Firefighters Local 372.

Pritchard turned around a comparison that has been used to promote the deployment model, saying that patients will get the same level of service for a stubbed toe as they would for a heart attack.

"That's an inefficient use of resources," Pritchard said.

DuRee, a past union president, acknowledged the effect of budget pressures on the proposal - the firefighters union said 77 sworn firefighters have been eliminated since 2004 - but added that just because fiscal problems have necessitated the shift doesn't mean that it's not the best use of resources.

In Long Beach, 84 percent of fire department calls are medical incidents, according to LBFD data, and this year's main budget challenge was maintaining four-person fire engine staffing.

Command staff looked at paramedics driving ambulances while their partners provide care to a patient as the most inefficient cog in the city's EMS response system, DuRee said, leading to the decision to change the model to preserve four-member engine crews.

Some City Council members are leery of the proposal, which was approved unanimously in September's budget vote.

DuRee has committed to bringing it back to the council if the county EMS Agency green lights what would be a two-year trial.

"I'm concerned about (firefighter) safety and the effectiveness of the work they may do. If it were up to me, I would maintain the current model," said Councilman Al Austin. "I hope that our budget situation improves in the near future."

Councilman Gary DeLong, who supports the plan, said departments faced with limited funds need to either reduce services or find a creative way to repackage those services.

He also pointed out that 28 of the state's 32 EMS agencies use a one paramedic, one EMT deployment, with only Los Angeles, Orange, Contra Costa and Santa Cruz counties retaining a two-paramedic system. Long Beach has used its staffing model since 1973.

"The chief has been able to demonstrate that our old service model is the minority," said DeLong.

The average response time for an advanced medical call requiring a paramedic increased 24 seconds in 2012, to 6 minutes and 50 seconds, according to the Long Beach Fire Department.

An emergency medical technician arrived at the scene of a basic life support call, on average, in six minutes and 11 seconds, a 15-second decrease from the prior year.

LBFD Chief DuRee attributed the increase in paramedic response time to budget cuts.

"We're managing more calls with fewer resources," DuRee said.

Fire officials anticipate a 5 to 10 percent increase in call volume each year. The LBFD treats about 45,000 patients annually, according to DuRee.

The National Fire Protection Association promotes standards that call for the first unit, with at least one paramedic, to get to the scene of an advanced life support call within a total time of eight minutes.

For basic life support calls, the first unit with at least one EMT should arrive within six minutes, the NFPA says.

DuRee said he expects a proposed budget-related shift to a one paramedic, one EMT response to every call to reduce paramedic response times by 40 seconds.